International Day of the Midwife

Women and Families Face Consequences of Maternity Workforce Shortage

On the 5th day of May each year, Frontier Nursing University joins the rest of the world in recognizing International Day of the Midwife. We choose to do so by focusing on the outcomes of midwifery-led care. One of our main goals as a leading educator is to reach others who may be thinking about a career in nurse-midwifery. We strongly advocate for integrating midwifery into the health care system to improve access to care because the nurse-midwife plays an important role in maternity and primary care for women, as well as the health of the family.

Rising Maternal Mortality in the U.S.

One of the biggest concerns facing our society is the rising maternal mortality rate in the U.S. We have the most expensive health care system in the world, yet American women are more likely to die during childbirth than women in any other developed country. The U.S. has experienced a continued increase in the maternal mortality ratio, which was 7.8 per 100,000 live births in 1987 and climbed to 22 per 100,000 live births in 2014.

Frontier educates nurse-midwives to seek opportunities to lead positive change. Rising maternal mortality is a complex issue, and contributing factors extend beyond medical complications. There are financial, bureaucratic, transportation and language barriers, as well as social concerns and a shortage of maternity care facilities and providers. The obstetrician-to-patient ratio is much less than it was 20 years ago, and the number of family physicians providing maternity care has decreased from 25 percent at the turn of the century to 10 percent as of 2010 … just 10 years later.

Health Disparities and Inequality

As community hospitals shut their doors, rural communities are some of the most affected areas. According to the American College of Obstetricians and Gynecologists, 49 percent of all U.S. counties do not have an ob-gyn. And while 23 percent of women live in rural areas, only seven percent of ob-gyns practice in rural areas. Additionally, health care insurance coverage is not a guarantee in the U.S. which can lead to difficulty accessing care and increasingly worse health outcomes.

A 2007 National Center for Health Statistics study showed that non-Hispanic black women are three times more likely to die than non-Hispanic white women during childbirth. While that study is 10 years old, we are not seeing any improvement. Racial disparity is highly evident in Washington, D.C., where the maternal mortality ratio is the highest in the country. However, if you examine the statistics for white women living in Washington D.C., they have the lowest maternal mortality ratio in the country. Thus, health equity must continue to be another priority for nurse-midwives.

Improving Access to Quality Care

Accessibility to quality health care should be a social goal and a human right. Effective access includes convenient locations and hours; economic and informational resources; an adequate number and choice of providers; and appropriateness of services provided. Also key to patients seeking care are social determinants, such as confidentiality, perceptions of quality and cultural sensitivity.

At Frontier Nursing University, we are working to increase not only the number of certified nurse-midwives, but also increase diversity among those who provide maternity care in rural and underserved areas. Through our distance education model, we educate nurse-midwives in their home communities. We were delighted when the American Midwifery Certification Board recently reported a record number 11,600 certified nurse-midwives. But there is more work to be done. Our goal is to dramatically increase the number of nurse-midwives in the U.S., as they are desperately needed in order to meet the health care needs of women and families.

It’s important to note that midwifery-led care can result in better outcomes, according to a recent Cochrane Review. For example, there is more continuity of care, fewer pre-term and instrumental births, higher maternal satisfaction and a cost-savings compared to medical-led care.

As educators and providers, the onus falls on us to promote primary and preventative care and collaborative health care environments. We must strive to continue to collect more data to better understand the factors that lead to maternal mortality and poor health outcomes, and then develop programs to address those issues. And finally, we must diversify the health provider workforce so that patients are more likely and willing to participate in care.

We invite you to learn more about nurse-midwifery led care at Frontier.edu.

About Author

Dr. Susan Stone is the President of Frontier Nursing University and can be reached at susan.stone@frontier.edu. Frontier Nursing University is the birthplace of nurse-midwifery and family nursing in America.